Elevating the Post-Acute and
Long Term Care Profession

June 28, 2021

Conference Committee Finalizes Budget. After a five-hour delay, the joint conference committee of the House of Representatives and the Senate met this afternoon to adopt a conference report on the state biennial budget bill, House Bill 110. The conference committee made numerous changes to the Senate version of the budget, most notably to education funding and tax cuts, but also addressed items affecting long-term services and supports providers. The budget, as revised by the conference report, is going to the floors of both legislative chambers tonight. Then it will go on to Governor Mike DeWine for his signature and line-item vetoes by midnight Wednesday. Key provisions of the conference report do the following: 

  • Cap SNF rate rebasing at $125 million per year (a $49 million reduction from the Senate version) and specified that 70% of the rebasing amount for each SNF must be spent on direct care. The bill now includes provisions for the Department of Medicaid (ODM) to audit spending and to take back any money not spent as directed. ODM can write rules to implement this requirement. The conference reports specifies that the 70% requirement will apply to future rebasings and capital will not be rebased in the future. That being said, the bill creates a legislative study committee to review the entire reimbursement system, with a report due in August 2022.
  • Increase the SNF quality incentive to $125 million above the current level in State Fiscal Year (SFY) 2023. The incentive stays at $25 million above continuation, as prescribed by the Senate version, in SFY 2022. The language for the incentive is essentially the same as the Senate version (excluding from the incentive facilities below the 25th percentile, Special Focus Facilities (SFFs), and centers that have changes of provider), except the 80% occupancy threshold would be reinstated after the biennium. The incentive itself, however, sunsets at the end of the biennium.

  • Keeps the total funding for SNFs the same as in the Senate bill, but back-weights it to SFY 2023 and shifts money from rebasing to quality.
  • Adopts the Senate version relative to funding for ICFs/IID and ID/DD waivers (essentially, 2% increase each year), but removes language in the Senate bill prohibiting the Department of Developmental Disabilities from dedicating funding to exit waivers, as required by the Ball v. Kasich settlement.
  • Adopts the Senate version relative to funding for Department of Aging and ODM home and community-based services (assisted living, PASSPORT, Ohio Home Care, state plan home health), which is a 4% increase in the first year of the budget and 2% in the second year, but replaces the funding for PASSPORT adult day services with the House appropriation of $5 million per year.
  • Restores the House language on health orders against SNFs and residential care facilities and on early termination for SFFs.
  • Retains the agreed-upon home health licensing language per the Senate version.
We will provide further detail on the budget in the coming days.

CMS Proposes Home Health Payment Rule for CY 2022. CMS today issued its annual Medicare payment update rule for home health agencies, to take effect for calendar year (CY) 2022. The 387-page rule proposes a net 1.7% update factor after the statutorily-mandated 0.1% reduction to the rural add-on, worth an estimated $310 million to the industry nationally. CMS looks to make a number of other changes to home health payment, most notably implementing the Home Health Value-Based Purchasing Model nationwide. Previously, CMS piloted this model only in certain states. We will provide more detail on the proposed rule, which is open for comment until August 27, 2021, in this week's Home Care News Bites. CMS also published a fact sheet that summarizes the proposed changes.

Details of Temporary Nurse Aide Legislation. Last week, the legislature completed work on Senate Bill (SB) 6 by inserting language that creates a pathway, based on federal guidance, for temporary nurse aides (TNAs) to become state-tested nurse aides (STNAs). Governor DeWine has not yet signed the legislation, which primarily deals with an interstate medical compact. The measure will take effect 90 days after the Governor signs it. SB 6 creates an exception for TNAs to the normal, 75-hour nurse aide training course. To qualify for the exception, a TNA must complete, during the federal COVID-19 Public Health Emergency, at least 75 hours of training in a SNF that:

  • Includes on-site observation and work as a nurse aide under a Centers for Medicare and Medicaid Services (CMS) COVID-19 pandemic waiver (i.e., the waiver allowing TNAs).

  • Addresses all of the required areas specified in the federal regulations for nurse aide training, except that if gaps in on-site training are identified, the individual also must complete supplemental training.

A TNA who meets these qualifications can sit for the test to become a STNA and to be placed on the registry. Presumably, the facility where the TNA worked will need to supply documentation of the on-the-job training, but we do not know yet what specifically will be required.

ODH to End Nurse Aide Training Rule Waivers. Completely unrelated to SB 6, except for coincidental timing, the Health Department (ODH) sent a notice today via the Enhanced Information Dissemination and Collection (EIDC) System with the subject, "Suspended Administrative Code for NATCEP End Date." This rather confusingly-titled missive actually pertains to three waivers of state Administrative Code rules that ODH issued in the spring of 2020 to give greater flexibility to nurse aide training programs. These waivers did not in any way relate to TNAs, unless a TNA happened to enroll in an approved training program that made use of the waivers. The most noteworthy of the three waivers allows training programs to deliver the entire classroom portion of the training program online. In today's notice, ODH announced that they are removing the rule waivers effective August 17, 2021. Again, reinstatement of the existing rules applies only to any training programs that may have been using the waivers.

Latest CMS Positivity Ratings. Today saw release of new county positivity ratings. The CMS table for Ohio, like last week's, has only two yellow counties. Lawrence County is joined by Morgan County this week, as Holmes County turned green. Also interesting is that the vast majority of Ohio counties not only are below the 5% threshold for yellow status but also are below 2% positivity - many below 1%. Even Lawrence County is down to 6.1%, a considerable improvement over last week.

BWC Extends Indoor Air Quality Program Again. The Bureau of Workers Compensation (BWC) announced today that they extended the deadline for the Indoor Air Quality Assistance Program through December 31, 2021. This marks the third (and last possible) extension of the program, which "offers up to $15,000 in reimbursement for eligible entities to inspect and assess their air quality needs and address those needs through portable air filtration systems, new filtration systems, maintenance on current systems, and other interventions implemented on or after March 1, 2020, through Dec. 31, 2021." A variety of buildings operated by OHCA members qualify for grants to pay part of all of the cost of variety of air quality projects. The BWC press release adds that they have approved or are reviewing nearly 1,500 applications for $16.2 million in total funding and that the remaining money is on a first-come, first-served basis.

ODH Release on Vaccine-Related Cardiac Issues. ODH circulated an informational memo on recent actions by the Food and Drug Administration and the Centers for Disease Control and Prevention realting to cases of myocarditis and pericarditis after vaccination with the Pfizer and Moderna vaccines. While ODH circulated this information primarily to vaccine providers, it is of interest to anyone who wishes to allay concerns about the safety of the vaccines. The memo affirms that the federal agencies and ODH agree that the vaccines remain safe and that these adverse effects are very rare.